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The recommendations are dedicated to contemporary aspects of epidemiology, etiology, pathogenesis, diagnosis, etiology-based, pathogenetic and symptomatic treatment of myocarditis. Various pathogenetic mechanisms that cause the development and progression of inflammatory heart disease and cause dilatation and systolic dysfunction, lead to heart failure and the development of other complications of myocarditis are described in detail. These recommendations present the modern classification of myocarditis, approved in Ukraine, and modern algorithms for diagnosis and clinical management of patients, in particular the algorithm that justifies the appointment of glucocorticoids for patients with myocarditis. The characteristics of different variants of myocarditis are also presented with clarifications concerning diagnosis and treatment. Much attention is paid to various approaches to the etiotropic and pathogenetic treatment of myocarditis and their possible prospects. It is obvious that in order to standardize approaches to the diagnosis and management of acute and chronic myocarditis, it is necessary to conduct large-scale multicenter studies and create special registries. In addition, in the current context of the COVID-19 pandemic, the pathological effects of SARS-Cov-2 as a trigger of myocarditis need further study, in particular in terms of impact on the prognosis and approaches to pathogenetic therapy in such patients. Unification of terminology and approaches to diagnosis and clinical monitoring of patients with myocarditis can improve management tactics and increase the survival rate of such patients. To identify high-risk patients (with arrhythmias, high probability of recurrence or transformation of myocarditis into dilated cardiomyopathy) and candidates for heart transplantation, the most promising is the creation of special databases of such patients

The aim – to evaluate the effectiveness of glucocorticoid therapy in patients with myocarditis with reduced left ventricular ejection fraction that developed after COVID-19 infection.Materials and methods. The results of glucocorticoid therapy in 32 patients aged (35.2±2.3) years with acute myocarditis after COVID-19 infection and left ventricular ejection fraction < 40 % are presented. All patients were prescribed a 3-month course of methylprednisolone at a daily dose of 0.25 mg/kg, followed by a gradual dose reduction of 1 mg per week until complete withdrawal 6 months after the start of treatment.Results and discussion. The analysis of the results of the examinations was performed in the 1st month from the onset of myocarditis to the appointment of glucocorticoids and after 6 months of observation. Six months later, the end-diastolic volume index decreased by 18.5 %, the left ventricular ejection fraction increased by 23.8 %, and the longitudinal global systolic straine increased by 39.8 %. On cardiac MRI, the number of left ventricular segments affected by inflammatory changes decreased from 6.22±0.77 to 2.89±0.45 segments, and the number of segments with fibrotic changes did not change significantly. After 6 months of treatment, there was a significant decrease in the concentrations of proinflammatory cytokines and cardiospecific antibodies.Conclusions. The use of a 6-month course of glucocorticoid therapy in patients with myocarditis that developed after COVID-19 infection improved the contractility of the left ventricle against the background of a significant reduction in inflammatory lesions of the left ventricle and reduced concentrations of proinflammatory cytokines and cardiospecific antibodies.

The article is devoted to cardiac resynchronization therapy (CRT) – the method for chronic heart failure treatment with biventricular pacing. The article examines the history of the method development from the first attempts to eliminate heart dyssynchrony to the present. Over the past 20 years, the method has been improved both in technical terms and in terms of the formation of modern indications for its application. Based on the results of randomized clinical trials to study the effectiveness of the method, the improvement of the testimony and criteria for the selection of patients for the CPT is shown. A clinical case of successful CRT in a patient with cardiomegaly, severe heart failure and complete left bundle brunch block is described.

The choice of adequate tactics for the treatment of myocarditis is particularly relevant today, and the most controversial among modern scientists and practitioners is the question of prescribing etiology-based and pathogenetic treatment. One of the most pressing and complex issues at the present stage is the problem of developing adequate schemes for etiology-based and pathogenetic treatment of severe chronic myocarditis, as so far the only recommended strategy is the treatment of heart failure according to current recommendations. The appointment of etiotropic therapy in patients with myocarditis may be appropriate in the acute phase of the disease and must take into account the results of endomyocardial biopsy. Immunosuppressive therapy should be used only in patients with severe myocarditis in the presence of conclusive evidence of active inflammatory process in the myocardium with mandatory re-examination after completion of its course to monitor safety and efficacy. In the presence of dilatation of the left ventricle and a reduced left ventricle ejection fraction, the basis for the treatment of myocarditis is the patient’s compliance with dietary restrictions and the use of standard heart failure therapy according to current recommendations. However, a large number of issues related to the management of patients with myocarditis remain debatable, so leading world scientists recognize the need for further research to assess the effectiveness of etiology-based and pathogenetic therapy.

Nowadays the diagnosis and prognosis of myocarditis is one of the most pressing, complex and incompletely solved problems in modern cardiology, that exist due to the large polymorphism of clinical manifestations of this disease and because of the lack of specific symptoms and diagnostic criteria. In most cases, the occurrence of heart failure, pain, heart rhythm and conduction disorders or other clinical manifestations are observed on the 2nd week after the onset of infectious disease, but inflammatory heart disease may not have a clear connection with the infection. Among the main methods used to diagnose myocarditis in clinical practice are electrocardiography (ECG), Holter monitoring (HM) ECG, echocardiography (echocardiography) and speckle-tracking (ST) echocardiography, cardiac magnetic resonance (CMR) imaging and endomyocardial biopsy. ECG and HMECG are highly informative methods for detection, prediction and dynamic monitoring of frequent complications of myocarditis – arrhythmias and conduction disorders. Two-dimensional echocardiography is a mandatory technique for assessing myocardial contractility that allows to assess the size of the heart chambers, systolic and diastolic function, global and regional contractility, the presence of thrombosis in the cavities, pericardial effusion and, most importantly. In recent years, there has been increasing data on the use of CT echocardiography for the diagnosis of myocarditis, based on the assessment of myocardial deformation and its rate in the longitudinal, radial and circular directions. Contrast-enhanced magnetic resonance imaging of the heart is non-invasive and one of the most informative methods for detecting signs of inflammatory myocardial damage. CMR allows to visualize the anatomy, study the structure and characterize the tissue of the heart, determine the functional features of the atria and ventricles. However, the gold standard for verifying the diagnosis of myocarditis to this day remains endomyocardial biopsy. Laboratory methods of diagnosis are additional researches, that in a complex with instrumental methods allow to estimate changes of myocardial inflammatory process at long supervision.

Diagnosis and prognosis of myocarditis course remain one of the most complex and unsolved problems of contemporary cardiology, not only in Ukraine but also in the developed countries of the world. It is well known that in order to develop adequate methods of diagnosis, treatment and prevention of complications, fundamental knowledge regarding the pathogenetic mechanisms of the development and progression of a particular disease is necessary. In the pathogenesis of impaired cardiac function and its dilation in both acute and chronic stages of myocarditis, the primary role played by immunopathological reactions manifested by autoimmunization and hyperreactivity against the structural elements of the heart muscle. The pathogenetic mechanisms of viral myocarditis are based on a complex of factors – direct cytotoxic effect of virus on cardiomyocytes, activation of apoptotic processes, as well as reactions of primary and secondary immunity, microvascular lesion, remodeling of the contractile apparatus of the heart muscle. The main proinflammatory cytokines produced by immune cells in the inflammation zone are: γ-interferon, tumor necrosis factor-α, interleukin (IL) 1β, IL-2, IL-6, IL-17A, IL-23. Another mechanism of myocardial contraction is associated with the activation of immunopathological responses of the humoral type with the synthesis of cardiospecific antibodies, in particular to the β1-adrenoceptor, cardiac myosin, actin, laminin, vimentin and other structures of the heart muscle. A significant role in the pathogenesis of myocarditis is now given to stimulation of Toll-like receptors of type 2 and type 4 and activation of matrix metalloproteinases, which has a direct relationship with the production of proinflammatory cytokines. Promising to clarify some of the pathogenetic mechanisms of inflammatory heart damage is currently considered the study of different microRNAs types. Currently, the world cardiology community recognizes the relevance of further study of the various mechanisms of myocarditis pathways in order to identify those pathogenetic links, the impact of which can reduce the pathological effect of inflammatory cardiac damage and the severity of the disease and improve prognosis for patients with myocarditis. Diagnosis and prognosis of myocarditis course remain one of the most complex and unsolved problems of contemporary cardiology, not only in Ukraine but also in the developed countries of the world. It is well known that in order to develop adequate methods of diagnosis, treatment and prevention of complications, fundamental knowledge regarding the pathogenetic mechanisms of the development and progression of a particular disease is necessary. In the pathogenesis of impaired cardiac function and its dilation in both acute and chronic stages of myocarditis, the primary role played by immunopathological reactions manifested by autoimmunization and hyperreactivity against the structural elements of the heart muscle. The pathogenetic mechanisms of viral myocarditis are based on a complex of factors – direct cytotoxic effect of virus on cardiomyocytes, activation of apoptotic processes, as well as reactions of primary and secondary immunity, microvascular lesion, remodeling of the contractile apparatus of the heart muscle. The main proinflammatory cytokines produced by immune cells in the inflammation zone are: γ-interferon, tumor necrosis factor-α, interleukin (IL) 1β, IL-2, IL-6, IL-17A, IL-23. Another mechanism of myocardial contraction is associated with the activation of immunopathological responses of the humoral type with the synthesis of cardiospecific antibodies, in particular to the β1-adrenoceptor, cardiac myosin, actin, laminin, vimentin and other structures of the heart muscle. A significant role in the pathogenesis of myocarditis is now given to stimulation of Toll-like receptors of type 2 and type 4 and activation of matrix metalloproteinases, which has a direct relationship with the production of proinflammatory cytokines. Promising to clarify some of the pathogenetic mechanisms of inflammatory heart damage is currently considered the study of different microRNAs types. Currently, the world cardiology community recognizes the relevance of further study of the various mechanisms of myocarditis pathways in order to identify those pathogenetic links, the impact of which can reduce the pathological effect of inflammatory cardiac damage and the severity of the disease and improve prognosis for patients with myocarditis. Diagnosis and prognosis of myocarditis course remain one of the most complex and unsolved problems of contemporary cardiology, not only in Ukraine but also in the developed countries of the world. It is well known that in order to develop adequate methods of diagnosis, treatment and prevention of complications, fundamental knowledge regarding the pathogenetic mechanisms of the development and progression of a particular disease is necessary. In the pathogenesis of impaired cardiac function and its dilation in both acute and chronic stages of myocarditis, the primary role played by immunopathological reactions manifested by autoimmunization and hyperreactivity against the structural elements of the heart muscle. The pathogenetic mechanisms of viral myocarditis are based on a complex of factors – direct cytotoxic effect of virus on cardiomyocytes, activation of apoptotic processes, as well as reactions of primary and secondary immunity, microvascular lesion, remodeling of the contractile apparatus of the heart muscle. The main proinflammatory cytokines produced by immune cells in the inflammation zone are: γ-interferon, tumor necrosis factor-α, interleukin (IL) 1β, IL-2, IL-6, IL-17A, IL-23. Another mechanism of myocardial contraction is associated with the activation of immunopathological responses of the humoral type with the synthesis of cardiospecific antibodies, in particular to the β1-adrenoceptor, cardiac myosin, actin, laminin, vimentin and other structures of the heart muscle. A significant role in the pathogenesis of myocarditis is now given to stimulation of Toll-like receptors of type 2 and type 4 and activation of matrix metalloproteinases, which has a direct relationship with the production of proinflammatory cytokines. Promising to clarify some of the pathogenetic mechanisms of inflammatory heart damage is currently considered the study of different microRNAs types. Currently, the world cardiology community recognizes the relevance of further study of the various mechanisms of myocarditis pathways in order to identify those pathogenetic links, the impact of which can reduce the pathological effect of inflammatory cardiac damage and the severity of the disease and improve prognosis for patients with myocarditis.

The aim – to investigate the dynamic changes of the structural and functional state of the heart and the persistence of cardiac rhythm disorders in patients with acute myocarditis with preserved left ventricular ejection fraction (LV EF) during 6 months of follow-up. Materials and methods. 54 patients with acute myocarditis and preserved LV EF (> 40 %) of the left ventricle (LV) were screened. The examination was performed twice: in the first month from the debut of myocarditis and in 6 months of follow-up. Results and discussion. According to data obtained by CMR, in the 1st month from the disease onset, the early contrast on T1-weighted images and/or the high intensity of the signal on T2 images were detected in all patients, with their percentage being 66.6 % and 62.9 % respectively, and late enhancement was observed in 14.8 % of cases. After 6 months of observation, edema and myocardial hyperemia were detected only in 7.4 and 9.2 % of cases, and fibrotic changes were in 37.0 % of patients, while 59.2 % of patients had no pathological changes on CMR at all. The average number of affected by inflammatory changes LV segments in the 1st month was 2.33±0.23, and after 6 months it decreased to 1.43±0.17 segments (р

The aim – to establish differences in the structural and functional state of the heart in patients with chronic myocarditis and dilated cardiomyopathy and to investigate their associations with the presence of cardiac rhythm disorders. Materials and methods. We included 95 patients who were divided into two groups: the first group consisted of 55 patients with chronic myocarditis (CM), the second group included 40 patients with dilated cardiomyopathy (DCM). All patients had heart failure (HF) II or higher functional class (FC) according to the classification of the New York Heart Association (NYHA) and a reduced left ventricular (LV) ejection fraction (EF). All patients underwent the echocardiography (EchoCG) with speckle tracking (ST), Holter electrocardiogram monitoring and cardiac magnetic resonance (CMR) imaging. Results and discussion. A comparative analysis of the EchoCG data revealed that CM was characterized by lower values of LV end-diastolic and end-systolic volume indexes (by 21.7 and 28.6 %, respectively, p

Нами досліджено діагностичну цінність магнітно-резонансної томографії (МРТ) серця та спекл-трекінг ехокардіографії у хворих з клінічно підозрюваним міокардитом. Обстежено 62 пацієнти з клінічно підозрюваним дифузним міокардитом на 1-му місяці від дебюту захворювання та через 12 міс спостереження. В результаті проведених досліджень встановлено, що на 1-й місяць від дебюту дифузного міокардиту спостерігається значна дилатація лівого шлуночка (ЛШ) та зниження його скоротливої здатності, що обумовлено активним запальним процесом, а через 12 міс спостереження на фоні регресу набряку і гіперемії та розвитку фібротичних змін міокарда відбувається поступове відновлення скоротливої функції серцевого м'яза. У хворих на дифузний міокардит запальні зміни міокарда, виявлені при МРТ серця, асоціюються з порушенням глобальної скоротливості ЛШ як в дебюті захворювання, так і через 12 міс спостереження.